Podcast Episode 20: Multiple Mini Interviews (MMI)

Med School Coach’s own Renee Marinelli sits down today to talk to us about multiple mini interviews (MMI). About 50% of medical schools are using MMI instead of the traditional type of interview, and the MMI is quite different. It is composed of several stations (usually five to eight), and at each station you are given a different scenario. They can be an ethical scenario, a role-playing scenario, or a scenario where you just discuss an issue. You get a small amount of time to review the scenario and then go into a room with an interviewer to discuss it. Sometimes they have follow-up questions, and sometimes they don’t.

Renee talks about the scenarios that she usually sees and how they should be approached to give us an idea of how to prepare. She shares specific prompts and goes through examples of what a good response should consist of and the thinking behind it.

[2:01] The Different Types of Scenarios.

Ethical scenarios revolve around decision making when it comes to a patient, and how you would handle that decision making as a physician. Some scenarios that Renee often sees are:

“An old woman is on life support and the husband wants to end the life support. What do you do?”

“You have one liver to give to a patient who needs a transplant. You have a 20-year-old woman and a 70-year-old man. How do you decide?”

“Somebody is refusing treatment at the hospital for an illness and you’re supposed to talk to that patient. What do you do?”

All of these are ethical scenarios where you’re forced to make a decision and navigate a situation that you may not be familiar with.

What Renee has seen to work the best is to first demonstrate understanding for the situation; just acknowledging that it’s difficult and showing empathy for the people at hand. Next, one of the greatest tools you can have in these ethical situations is the desire to ask for more information from the concerned parties, such as why they want to make certain decisions. However, be sure to speak theoretically during the MMI as to not expect the interviewer to provide more information. After understanding the information uncovered from the concerned party, you should say that they want to help them through it. This could include providing more clarity if the concerned party does not fully understand how ill their loved one is. Then, emphasize that you would just sit down and try to make a decision and be a support system for the concerned party.

Another thing to keep in mind is that it’s always okay to ask for help in the hypothetical situation. The interviewer is not expecting you to know every single answer or know the legal obligations of someone trying to make a surrogate decision for another person. That’s not what these questions are for. These questions are to see how you make decisions, how you process information, and how you can display your empathy to patients in difficult situations. Most medical centers have an ethics committee that is there to assist physicians and family in these situations.

[10:41] Scenarios Related to Policy and Critical Thinking Skills.

Situations that fall under these categories include weighing the pros and cons of abortion, stem cell research, patient confidentiality, medical marijuana, and so on. You can be put into a situation where you must critically think through it, such as if you have an obligation to report infectious disease to the CDC, or if you think medicine should be more about changing behavior to prevent disease or treating existing diseases. These are scenarios that you really just have to think through and discuss.

When you read the scenario outside of the room, take some time to think about it and really identify all the issues in the scenario. When going into the room to answer the question, have a logical structure in place; you can even say aloud the outline of the key points you will talk about. If the question specifically asks you to make a decision, such as “do you think…,” you should make that decision. If it asks you to “discuss,” you don’t necessarily take a stance; in fact, Renee advises against it. You should just discuss the pros and cons of the prompt.

[14:50] Role-Playing Scenarios.

Renee thinks that role-playing scenarios are fun, but many people find them difficult to practice. Some scenarios that she has seen are:

“You’re a third-year medical student and one of your fellow medical students show up to rounds drunk, so you approach him.”

“A patient is asking you for prescription painkillers and you see no reason why they have a need for them.”

“You have to go talk to somebody who is upset.”

These scenarios are reflective of ones you will have as a physician. You will come across patients that don’t agree with your treatment plan, patients that are upset, and people that are not behaving appropriately.

For these types of questions, it is, again, good to acknowledge the difficulty of the situation. You can start off by showing compassion and recognizing what the person is going through. Next, try to get them to open up to you as opposed to accusing them of wrongful behavior. Ultimately, if they’re not opening up to you, then it’s time to be a little more blunt.

Always remember to do the right thing. Take all necessary precautions in the situation, and then talk about how you can help the person. If they do not get help, express that you would take appropriate action.

[19:59] Closing Remarks.

All of these scenarios are slightly different, but they usually do have common themes to them. If you practice enough of them, you can start to pick out these themes and pick out what it is you can work through and how you can use these tips.